溶栓治疗急性心肌梗死血管再通早晚与心室功能的关系

为了探讨溶栓治疗血管再通时间早晚与心脏功能的关系，对急性心肌梗死（ＡＭＩ）患者接受静脉溶栓治疗后，２周￣３周行心脏超声测定左室射血分数（ＬＶＥＦ）及短轴收缩率（ＦＳ）。结果：发病后６ｈ￣１２ｈ期间溶通之患者较６ｈ内者其ＬＶＥＦ及ＦＳ明显减低，室壁瘤、Ｋｉｌｌｉｐ０     

急性脑梗死溶栓治疗的血管再通率

评价急性脑梗死的溶栓治疗的效果。使闭塞的脑血管再通是溶栓治疗的基础。开展急性脑梗死的溶栓治疗 ,需要探讨急性脑梗死的血管闭塞率和自然再通率 ,了解动脉和静脉溶栓治疗的血管再通率 ,以及影响溶栓治疗血管开通的因素。针对上述有关问题 ,我们结合自己的临床实践进行了文献系统综述     

缩短急性心肌梗死患者发病到溶栓时间试验

目的探讨院前溶栓是否能明显缩短急性心肌梗死患者从发病到开始溶栓的时间,了解院前溶栓的可行性和安全性.方法将60例急性心肌梗死患者随机分为院前溶栓组和入院后溶栓组,各30例.院前溶栓组患者的溶栓场所是在其家中、工作场所、救护车上或急救中心,诊断急性心肌梗死后立即给重组链激酶150万单位静脉点滴.对照组的患者按常规迅速办入院手续,而后按上述方法立即溶栓.结果从发病到开始溶栓的时间院前溶栓组(104±43)min,入院后溶栓组(256±121)min(P＜0.01).按临床标准判断冠状动脉再通率立即溶栓组70.3%,对照组51.5%(P＜0.01).结论入院前溶栓,明显缩短急性心肌梗死患者从发病到开始溶栓的时间,增加患者冠状动脉的再通率.初步看未增加溶栓并发症,认为安全可行.     

老年人急性心肌梗死的溶栓治疗

老年人急性心肌梗死的溶栓治疗叶平，牟善初急性心肌梗死（ＡＭＩ）的溶栓治疗是８０年代以来治疗ＡＭＩ的基础疗法。近年来随着国际上多项临床协作试验证实对老年人ＡＭＩ的疗效，在老年人中应用溶栓治疗也日趋增多［１，２］。然而，由于老年人ＡＭＩ病情重、并存症多、...     

静脉溶栓治疗对糖尿病并发急性心肌梗死患者近远期效果的影响

目的:本研究探讨静脉溶栓治疗对糖尿病并发急性心肌梗死(AMI)患者近远期效果的影响。方法:对本院连续住院治疗的116例AMI的溶栓治疗患者,按临床诊断分成糖尿病组(n=26)、非糖尿病组(n= 90)。根据胸痛症状、心电图ST段抬高和下降情况及心肌酶水平峰值变化,采用中华医学会心血病学分会制定的间接标准及其组合判断方法评定梗塞相关血管是否再通,随访观察和分析2组治疗效果。结果:开始溶栓时间:糖尿病组平均为(5.69±2.24)h,非糖尿病组平均为(4.68±1.80)h,两组比较糖尿病组时间延长,有显著性差异(P<0.05)。梗塞血管再通:糖尿病组有13例,再通率为56.5%,非糖尿病组66例,再通率为75.9%,两组再通率相比,糖尿病组明显低于非糖尿病组,有显著性差异(P<0.025)。心力衰竭发生率在糖尿病组溶栓后有42.3% (11例),非糖尿病组21.1%(19例),两组发生率比较糖尿病组严重心力衰竭的发生率高于非糖尿病组,有显著性差异(P<0.05)。住院病死率在糖尿病组死亡5例(占19.2%),非糖尿病组死亡9例(占10.0%),两组相比,糖尿病组死亡率有增多趋势,但尚无显著性差异(P>0.05)。平均随访5.6年(2.2～7.5年),糖尿病组病死率高于非糖尿病组(P<0.05)。结论:糖尿病并发急性心肌梗死患者经溶栓治疗后,仍有较差的近期及远期预后,其溶栓治疗再通率较低,与糖尿病患者开始溶栓时间延迟有关。     

急性心梗溶栓治疗的并发症

大量研究证明,急性心肌梗塞发病后及早进行有效的溶栓治疗,可缩小梗塞面积,保护心功能,降低病死率。经100,000例统计,急性心梗患者溶栓的病死率比不溶栓者降低10％～50％。但随着溶栓治疗的广泛应用,各类并发症时而出现,已引起了临床的极大关注。现概述如下。 1.出血:由于溶栓作用消耗了机体内大量的凝血因子所致。出血分为颅内出血和全身性出血两大类:①颅内出血:发生率为0.2％～1.0％,由于此类患者多有意识障碍,或由于病情危重而难以进行CT或磁共振检查,因此颅内出血的实际发生率肯定还要高,其病死率可达54％～61％。 颅内出血的原因不尽相同,但多与溶栓的病例选择不当有关。6个月内有中风病史者、1个月内有头部损伤者、严重高血压者、伴出血性疾病者     

老年急性心肌梗死溶栓治疗的进展

急性心肌梗死 (ａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ ,ＡＭＩ)溶栓治疗开展 2 0年来 ,随着临床应用的逐渐普及和治疗经验的积累 ,多数患者因此受益。参考成年患者 (包括 6 5～ 74岁 )溶栓治疗获益的证据 ,1996年ＡＣＣ/ＡＨＡ(ＡｍｅｒｉｃａｎＣｏｌｌｅｇｅｏｆＣａｒｄｉｏｌｏｇｙ/ＡｍｅｒｉｃａｎＨｅａｒｔＡｓｓｏｃｉａｔｉｏｎ)治疗指南指出年龄不再是溶栓的禁忌证 ,年龄≥ 75岁 ,ＳＴ段抬高 ,发病时间不超过 12ｈ诊断为ＡＭＩ者 ,在经慎重权衡利弊后仍支持溶栓治疗者 ,应即时给予溶栓。我国 1996年修改的ＡＭＩ…     

老年急性心肌梗死患者不同时段溶栓治疗对血管再通的影响研究

目的 探讨不同时段溶栓治疗对老年急性心肌梗死患者血管再通影响.方法 回顾性分析我院2009年12月-2011年4月收治的30例老年急性心肌梗死患者临床资料,观察各组患者溶栓治疗后的血管再通率、心脏事件发生率、病死率、并发症率.结果 发病后6h内与6h以上溶栓患者相比,血管再通率的差异有显著性(P＜0.05),患者发病时间的不同,平均血管再通所需时间不一,发病6h内与6h以外血管再通时间相比差异有统计学意义(P＜0.05).结论 老年急性心肌梗死患者发病后不同时段溶栓与其疗效密切相关,发病后6h以内溶栓效果最好.     

急性心肌梗死溶栓时间对血管再通和近期预后的影响

目的研究急性心肌梗死发病后不同时间溶栓治疗对血管再通和预后的影响.方法根据溶栓时间将64例分成≤4h,＞4～6h和＞6～12h三组,比较血管再通率、再通所需时间及对近期预后的影响.结果血管再通率分别为73%,66.2%,49.4%(后者与前二组相比差异有显著性,P＜0.05);血管再通所需时间与发病至溶栓的时间呈正相关,分别为58.9±32.1min,89.4±28.5min和109.1±30.2min(P＜0.05).室性心律失常和心绞痛的发生率以基本通畅组为最高(P＜0.01),病死率以未通组为最高(P＜0.01).结论急性心肌梗死发病6h以内血管再通效果最好,及时有效再灌注有利于改善急性心肌梗死患者的近期预后.     

85岁以上老年急性心肌梗死患者溶栓成功二例

1　临床资料病例 1,男性 ,90岁 ,因发作性心前区不适 32年 ,突发右肩胛疼痛 2h于 2 0 0 2年 7月 2 2日入院。既往有慢性支气管炎、阻塞性肺气肿病史 33年 ,高血压病 (3级 ) 10年 ,超声心动图提示三尖瓣 (前叶 )脱垂伴中度反流 3年。入院后心电图示ST段Ⅱ、Ⅲ、avF、V7～ 9抬高≥ 0 .4mV ,生化检查肌酸激酶4 2 81U L ,肌酸激酶同工酶升高 (CK MB ,2 5 7U L) ,确诊为下壁、正后壁ST段抬高的急性心肌梗死 (AMI)。遂于发病 4h内给予尿激酶 15 0万U进行静脉溶栓 ,溶栓 2h内心电图相关导联ST段回落≥ 5 0 % ,出现再灌注心律失常 ,患者疼…     

静脉溶栓冠脉再通对急性心肌梗死生存率的影响

目的：探讨静脉溶栓对急性心肌梗死存活率的影响。方法：对64例经静脉溶栓治疗的患,以临床血管再通为标准,对比分析再通组与未通组的存活率。结果：血管再通组存活率为97．6％,死亡率2．4％,未通组存活率为73％,死亡率27％,结论：急性心肌梗死静脉溶栓治疗是提高生存率的关键。     

急性心肌梗死静脉溶栓疗效与血脂相关性

目的 :观察血脂水平对急性心肌梗死 （AMI）患者静脉溶栓治疗效果的影响。方法 :对 3 8例 AMI患者的总胆固醇 （TC）、甘油三酯 （TG）、低密度脂蛋白 -胆固醇 （L DL -C）及高密度脂蛋白 -胆固醇 （HDL -C）于发病后 2 4h内进行测定 ,以中华心血管病杂志编委会 ,AMI溶栓疗法参考方案为标准 ,分为再通组 （3 0例 ） ,未通组 （8例 ）。结果 :溶栓再通组与未通组 TC、L DL -C、HDL -C比较差异无显著意义 ,未通组 TG明显高于再通组 （P<0 .0 5）。结论 :TG水平升高可能影响 AMI患者静脉溶栓效果 ,其机制及临床意义有待于进一步研究     

Continuous vectorcardiographic changes in relation to scintigraphic signs of reperfusion in patients with acute myocardial infarction receiving thrombolytic therapy

Objectives. Changes in the electrical activity of the heart reflecting the infarct process can be recorded by continuous vector-ECG, a method which is now clinically available for cardiac supervision. Shifts of the ST-segment and QRS-vector reflect ischaemia and necrosis of the myocardium. Continuous vector-ECG changes were evaluated against myocardial scintigraphy in 18 patients with acute myocardial infarction treated with streptokinase in order to study the impact of improved myocardial perfusion. Design. Myocardial perfusion was analysed with ⁹⁹Tc^m-Sestamibi (Cardiolite, DuPont Scandinavia AB, Kista, Sweden) single photon emission computerized tomography (SPECT). Registrations were performed before and after thrombolysis in order to estimate the amount of myocardium with impaired perfusion initially (threatened myocardium) and the degree of perfusion improvement in this myocardial area. X, Y, Z vectors were registered continuously by Frank leads (Ortivus Medical, Täby, Sweden). QRS-vector difference, and the time to plateau phase and the ST-vector magnitude were used as a measurement of ischaemia and size of the myocardial infarction. Results. In seven out of 11 patients treated within 3 h of onset of symptoms, an improvement in myocardial perfusion in the initially hypoperfused areas was achieved in contrast to none of the seven patients treated >3 h after onset of pain (P<0.05). In the whole patient material, there was a negative correlation between the time to plateau level for the QRS-vector and the improvement in myocardial perfusion (r=-0.53, P<0.05). Among patients treated within 3 h, there was a negative correlation between the plateau level for the QRS-vector magnitude compared to the improvement in myocardial perfusion (r=-0.61, P<0.05) and a negative correlation between the plateau level and the myocardial perfusion level after therapy (r=-0.69, P<0.05). In these patients, there were also negative correlations between the maximal ST-vector magnitude and the myocardial perfusion both before and after thrombolysis (r=-0.81, P<0.05 and r=-61, P<0.05, respectively). Conclusion. Patients with marked improvement in myocardial perfusion indicating successful thrombolysis reach their plateau levels of the QRS-change faster and have lower total QRS-vector differences than patients without successful thrombolysis as reflected by myocardial scintigraphy. Patients with a high ST-vector magnitude have low perfusion levels both before and after therapy indicating a pronounced ischaemic damage of the myocardium. Thus, VCG-changes reflect impairment in myocardial perfusion during acute myocardial infarction.     

基层医院尿激酶静脉溶栓治疗急性心肌梗死128例临床观察

目的探讨基层医院早期尿激酶静脉溶栓治疗急性心肌梗死的临床效果。方法回顾性分析128例以尿激酶静脉溶栓治疗的急性心肌梗死患者的临床资料,根据发病时间将患者分为3组（〈3h组,3～6h组及6～12h组）,比较3组经溶栓治疗后的再通率。结果 128例急性心肌梗死患者接受溶栓治疗,总再通率71.09%,无死亡患者。〈3h组再通率显著高于3～6h组[93.33%（28/30）vs.68.49%（50/73）,P〈0.05]及6～12h组[93.33%（28/30）vs.52.00%（13/25）,P〈0.05],差异有统计学意义。溶栓后2h内出现心律失常30例（23.43%）,溶栓24h出现上消化道出血2例（1.56%）,低血压2例（1.56%）,急性左心衰6例（4.68%）,经对症治疗未造成严重后果。结论尿激酶早期溶栓治疗急性心肌梗死患者能有效地挽救濒死心肌,改善患者的预后,是一种有效治疗方法。     

Prognostic importance of previous myocardial infarction in patients receiving thrombolytic therapy for acute infarction

This study evaluated the prognostic significance of reinfarction location by considering the previous site or type of myocardial infarction (MI) among 1601 patients with a history of previous MI who took part in the International (non-Italian) tPA/STK trial and/or the Israeli GUSTO study population. These patients were accordingly divided and hospital mortality was compared by six location groups as follows: acute inferior with previous inferior (8.1% hospital mortality), acute inferior with previous anterior (12.8%), acute anterior with previous inferior (13.3%), acute anterior with previous anterior (11.1%), acute inferior with previous non-Q-wave MI (7.6%), and acute anterior with previous non-Q-wave MI (11.2%) (p = 0.17 for comparison between the six groups). Hospital mortality tended to increase among patients with an anterior reinfarction compared with those with an inferior one (12.1% vs. 9.5%, p = 0.12). Among patients with a reinfarction at a different ECG location from the previous event, mortality tended to be higher compared with patients with two MIs at the same location (13.1% vs. 9.7%, p = 0.07). Recurrent MI following a previous Q-wave MI did not cause a higher mortality compared with a previous non-Q-wave type of MI (11.5% vs. 9.5%, p = 0.24). Among patients sustaining reinfarction, overall mortality did not differ between STK- and tPA-treated patients (11.0% vs. 11.4%, p = NS). In conclusion, the current study identified trends for higher mortality rates in patients with anterior compared with inferior reinfarction, with remote compared with the same ECG location of the two infarctions but not following a previous non-Q-wave compared with Q-wave MI. However, no particular combination of successive MIs location was significantly associated with a higher risk for hospital mortality.     

尿激酶溶栓治疗急性心肌梗死成功后相关冠状动脉形态动态观察

目的:观察急性心肌梗死(AMI)尿激酶溶栓成功后相关冠状动脉(冠脉)形态动态改变。方法:以溶栓成功的42例患者为观察对象,溶栓后90min和6个月时分别对其进行冠脉造影,然后用计算机辅助定量冠脉造影系统对溶栓后的冠脉病变处进行测量。结果:溶栓后90min42例患者中5例残余狭窄为90%～95%,32例残余狭窄为70%～90%,4例残余狭窄<50%,1例无明显狭窄;与溶栓后90min相比较,溶栓后6个月时34例患者残余狭窄无明显改变(P>0.05),7例残余狭窄明显改善(P<0.05)。结论:AMI静脉溶栓虽可挽救一部分濒临坏死的心肌,但大部分相关冠脉仍留有明显的残余狭窄,仍需行经皮冠脉介入术来解决残余狭窄问题。     

老年急性心肌梗死后梗死相关动脉再灌注对QT离散度的影响

目的了解老年急性心肌梗死(AMI)后梗死相关动脉(IRA)早期静脉溶栓再灌注或冠状动脉内支架置入术对QT离散度(QTd)的影响。方法对58例老年AMI患者(AMI组)予以静脉内溶栓,溶栓后选择性冠状动脉造影,对判定为心肌梗死溶栓试验性疗法(TIMI)2级以下者,部分行冠状动脉内支架置入术。溶栓前后测量分析QTd,并与48例冠状动脉造影正常的老年人(对照组)和50例健康体检非老年患者(非老年组)进行对照。结果AMI组溶栓前与对照组和非老年组间QTd有显著性差异(P<0.01);静脉溶栓后冠状动脉造影显示IRA血流达到TIMI 2~3级者,溶栓后2 h QTd显著降低,而IRA未开通者其QTd始终保持较高水平。16例溶栓前有室性心律失常者其QTd明显高于无心律失常者(P<0.05),结论IRA早期再灌注可使QTd显著降低,可减少恶性心律失常的发生。     

早期急性心肌梗塞静脉溶栓治疗的临床观察

目的观察静脉溶栓治疗早期急性心肌梗塞的临床疗效。方法随机选取我院48例心肌梗塞患者,采用尿激酶静脉溶栓治疗,对所有患者的临床治疗效率及相关资料进行回顾性分析。结果 48例急性心肌梗塞患者中,有37例患者达到再通标准,再通成功率为77.08%,11例未达到再通标准,发病后6h内进行静脉溶栓治疗的临床疗效要优于6-12h内行静脉溶栓治疗的临床疗效,两组再通成功率有差异性统计学意义(P0.05)。结论采用尿激酶静脉溶栓治疗早期急性心肌梗塞的临床疗效显著,同时治疗后并发症发生率较低,值得临床推广。     

Withholding thrombolysis in patients with diabetes mellitus and acute myocardial infarction

The benefits of thrombolytic therapy in a patient with diabetes having a myocardial infarction are now well accepted but this treatment may be withheld inappropriately because of concerns about retinal haemorrhage. We therefore examined whether junior doctors alter their use of thrombolysis for the treatment of acute myocardial infarctions according to the type of diabetic retinopathy present. A questionnaire asking whether thrombolysis would be given to a 50-year-old male smoker with insulin-treated diabetes and an acute anterior MI was shown, with four unlabelled retinal photographs, to all doctors prescribing thrombolytic therapy in a south London teaching hospital and an affiliated district general hospital. In all, 24 medical SHOs, 16 medical registrars/specialist registrars, 3 medical senior registrars, and 23 casualty SHOs were interviewed. Of these 89 % would thrombolyse such a patient with normal fundi, 55 % with background diabetic retinopathy, 54 % if this also involved the macula, and 26 % if they saw proliferative retinopathy. The more senior grades were more aggressive in their approach. As we believe that all patients with an acute anterior myocardial infarction and diabetes should be considered for thrombolysis irrespective of their retinal appearance these results suggest thrombolytic therapy is being withheld inappropriately. Copyright © 1998 John Wiley & Sons, Ltd.     

替罗非班在急性心肌梗死溶栓不同时期应用的疗效

目的观察替罗非班在急性心肌梗死溶栓不同时期应用的疗效及安全性。方法：87例sT段抬高型急性心肌梗死患者随机分为常规溶栓组（30例）、早期使用替罗非班组（溶栓前给药28例）和补救替罗非班组（溶栓失败后给药29例）。采用判断溶栓再通间接指标来评估3组患者梗死相关血管的再通率;观察患者出血的发生率及24 h内并发症。结果：早期应用组血管再通率明显提高,心肌肌钙蛋白I浓度峰值、肌酸激酶同工酶浓度峰值和达峰时间与常规溶栓组、补救应用组比较,明显降低和缩短（P〈0．05）,应用替罗非班后较常规溶栓组胸痛持续时间缩短,sT段下降时间提前（P〈0．05）。出血的发生率无统计学意义。在24 h内并发症方面,3组无明显统计学差异。结论：溶栓联合替罗非班,特别是早期应用者可以提高溶栓成功率,减轻心肌损害而不会增加并发症和出血风险。